The Life of a British Surgeon working at the Hospital in Nyon.

From Accidents to Arthritis. High Quality of Care for Patients, Quality of Life outside work Originally from Northern Ireland, Doctor John McManus is a consultant orthopaedic surgeon and joint head of the Department of orthopaedic and trauma surgery at the hospital in Nyon. He recently spoke to Living in Nyon about his experience of working in the Swiss health system and life for him in Switzerland. In 1998, John came on an exchange trip to stay with a French pen pal in the village of Metabief, close to the Swiss border near Vallorbe, and fell in love with the entire region from the start. “As soon as I arrived, the sun seemed to shine every day, there was great food and I enjoyed learning to ski. Even back then, I was determined to return; I could see this would be a great part of the world to live in. So, I set out to do everything I could to come back and to make a success of it.

As luck would have it, during my medical studies at Queen’s University in Belfast I was given the opportunity to go abroad for a year. Belfast has a link with Lausanne, and through cooperation between the different professors, I came to the medical school in Lausanne to teach human anatomy for a year. After completing a Bachelor’s degree in human anatomy, and obtaining my medical degree in 2007, I then studied for a Masters in Applied Biomechanics at the University of Strathclyde, at the same time as working as a junior doctor at the two university hospitals in Belfast.

Interesting and complicated cases I moved to Switzerland in 2009 and began my training in orthopaedics and trauma surgery at the CHUV. Then followed two years as chief-resident at the Riviera Chablais Hospital in Monthey and Aigle. You can imagine the number of interesting and complicated cases we had to treat, as the regional hospital at the base of Europe’s largest skiing area. I then returned to the CHUV where I specialised in the care of patients with knee and hip arthritis, as well as complications after joint replacement surgery.

Working at the hospital in Nyon – A real team approach amongst the staff I came to work at the hospital in Nyon in June 2018. I love it here; there is an excellent working atmosphere between the staff. Collaboration is key. Doctors, nurses and physiotherapists, all working together as part of a real multidisciplinary team, with the aim of ensuring rapid recovery after surgery or injury. This is such a refreshing way of working and gets better results. Up and Walking after the Same Day of Surgery Very often our patients are up and taking their first steps on the same day as their surgery. This is the new normal. For example, I operated on three patients yesterday (a hip and two knees) and all three were already up and walking on the same day of surgery with one of our physiotherapists. Medical and nursing staff are very much involved in the day to day running of the hospital; they work together, not against each other. There are four consultants in the department and between us we manage and make decisions ourselves, and as part of a larger team of all the consultants in the hospital. If we need something done quickly, we can do so. In bigger hospitals you may have to wait weeks for certain tests. Here we have the possibility to decide, and with a bit of luck, get things done very quickly. A case in point is a recent operation I performed on a British patient after he had a nasty skiing accident. He still had snow on his boots when he called me, and I was able to get him transferred to us and arranged for an MRI on the same day. From Accidents to Arthritis We deal with patients who have a variety of different problems, everything from accidents to arthritis. Each one of my colleagues has their specialist areas and expertise, but together we can provide world class medical care. There are many private clinics in the region, and while they can guarantee a better-quality plate for your dinner, there is no guarantee of better-quality medicine. Not everyone knows that we also have private and semi-private wings in the hospital, which are very comfortable and to a very high standard. Everyone is welcome here, no matter where they are from. Every single doctor in the hospital speaks English and translators are available for other languages if necessary.

We have very high-level people working here and expert surgeons. The orthopaedic team deal with shoulder, hip, knee and ankle arthritis, as well as problems affecting the wrist and hand, as well as every manner of trauma and sports injuries. In fact, there is no part of standard orthopaedics that we don’t cover, though for the most serious injuries, sometimes patients need to be transferred to the major trauma centres in Lausanne or Geneva, occasionally by helicopter. Taking the time with patients I come into work smiling and I may leave tired but am still smiling. It’s a long working day and sometimes coupled with long periods on-call, but there is still a good work life balance to be found. We treat our patients as individuals, and that requires taking the time necessary to clearly explain the diagnosis, and properly describe the risks and benefits of different treatment options. While our patients may have an appointment, we ensure the highest quality of care for our emergency cases as well, and sometimes that our appointments don’t always run to schedule, but we ensure the same high standard of care for everyone we see.

Having said that, if we don’t need to hospitalise a patient, we won’t. It doesn’t mean they are getting a lesser standard of care. If they come in with a broken wrist for example – a good plaster cast may be the right treatment; there is no point staying two days in a hospital bed if they don’t need it. Depending on the injury, surgery may be required, but it can be organised relatively quickly. I simply can’t imagine working now in the NHS or a big hospital where there is no possibility to make quick decisions or provide such high quality care. This hospital is well run and there is a sensible use of resources. This comes from the top down as we have a good management team, with clear input from all sectors of the hospital.

An increasingly elderly population, sometimes with complicated health issues Since I have been living in Switzerland, I have noticed that we are treating an increasingly elderly population, who more often than not have many different health problems which can complicate their care. Despite this, there are also a large number of aging but otherwise healthy patients who find themselves severely limited by joint pain due to arthritis. I recently operated on an 89-year-old patient, who thought that he would never be considered for surgery, but we gave him two new knee prostheses and he is over the moon – he now has a brand-new quality of life he didn’t think he would ever have again. Switzerland itself is the home and the origin of so much modern orthopaedics and trauma care, plates, screws and prosthesis continue to be developed here.

Smoking - Bad for bone healing Unfortunately, despite health promotion, there are still a lot of smokers in Switzerland. Everybody knows smoking is bad for your lungs and bad for your arteries, but they don’t realise is that it’s exceptionally bad for bone healing. The massive smoking lobby in Switzerland is one part of the problem and that smoking still seems to be socially accepted in this country. I don’t like it when you see both visitors and patients smoking near the entrance to the hospital, it sends out completely the wrong message. Work – life balance Despite working a lot, it is so important to take advantage of the excellent quality of which the region has to offer. I enjoy skiing, though winter is often a very busy time for us with so many injuries to treat. I live close to the hospital and am lucky enough to have a fantastic view over the lake. Even here when you look out the office window in the hospital you can see the Alps. You can also see the construction site where the hospital is currently working on a mammoth expansion plan, costing a planned 78 million francs, which is being spent on new buildings and there is a going to be a complete revamp of the site. We have to keep improving and have a long-term vision to provide for the health needs of the community.   Obviously the new buildings are going to be great for our patients, but also for the entire team here in Nyon.